Sexuality can take on special significance for people with cancer. Sex is an important part of most people's lives whether or not they have a partner, and the majority of those with a cancer will experience some sexual difficulty at some time or other.
Cancer is still a much feared diagnosis despite huge advances in therapy and survival. This is probably why so many doctors and other health care professionals avoid the subject of cancer's effects on sexual relationships. Many people with cancer also find it difficult to talk about.
Body changes are common as a result of both the disease and the medical and surgical treatments. Changes in body image, for example, can cause feelings of distress that go way beyond the physical effects of a cancer and its treatment.
Most of us take our bodies for granted as long as everything is going well and many feel that there is a link between mind, body and spirit. Being aware of these connections can greatly add to the healing process.
Most adults with cancer have had a sexual life before their cancer developed. Whenever someone has an illness that is affecting their loving, romantic, or sexual life they need to assess what their situation was like before. A relationship that was poor before a cancer is discovered probably won't be any better after the diagnosis. Having said that, some couples do come to a new understanding and love for one another as a result of overcoming a shared adversity such as cancer.
Perhaps one of the most difficult things to come to terms with about cancer and its effects on sex and relationships is the loss of potential. A cancer, or its treatment, could deprive you of having the family you'd long dreamed of. It could make you feel less attractive as a partner. It might detract from your longed-for career as a grandparent. In all of these cases the potential you thought you had for the future is now in question.
I often come across people who say they had all kinds of plans, spoken or unspoken, to enrich their relationship or sex life. Some look forward to their children leaving home so that they have more time, money and privacy to bring life back into their relationship. A cancer at this stage of life cheats them of this opportunity so long desired. It is perfectly normal to mourn this kind of loss.
These issues can be much more important than the direct physical effects on sexuality of having a cancer. True, physical sex can be enjoyable but most people say it's vastly more important to feel wanted, accepted, loved and `whole' than to have a brilliant sex life. Just being able to talk about how they feel can be equally important at times.
People feel much less like having sex when they have just been told their diagnosis or during the treatment of cancer. Survival is likely to be foremost in their mind. Underlying anger, frustration and grief often dampen sexual desire. Some people also say that they feel they should be grateful for being alive - not fretting about the deficiencies in their sex life. People who have a cancer will start, perhaps for the first time, to think about dying, their relationships with their partner, friends and relatives and their spiritual beliefs. Once we start to doubt our own future lifespan -- justifiably or not -- we look at sex differently.
In 1993 I surveyed 800 men over the age of 50 and found that about a third were not having sex. Other studies show that about 12 per cent of married couples of all ages are celibate. So please, when reading this booklet, don't think that sex is in any way compulsory. It is not. Certainly it can be healing, whether or not we have a life-threatening disease, but it will not necessarily cure you of anything in your mind, body or soul. And it can also be destructive. Guilt, fear and shame are linked with sexuality in the minds of some people in our culture. These emotions may be particularly upsetting to people with cancer, because the illness itself triggers these very same feelings in many people.